1. Introduction to Acute Oncology
Julie Skelton/Kristen Gibson
Acute Oncology Clinical Nurse Specialists

2. AIMS Overview of the Acute Oncology Service
Overview of cancer therapies
Primary complications/side effects of cancer treatment
Oncological emergencies
Neutropenic sepsis/Febrile Neutropenia
Malignant Spinal Cord Compression (MSCC)
Superior Vena Cava Obstruction (SVCO)
MUO/CUP
Contact details

3. Overview of the Acute Oncology Service
To provide acute care to patients who have adverse complications/side effects from:
their cancer diagnosis
following SACT, Targeted therapy or Radiotherapy
To provide expert advice for patient/relatives/other health professionals
Key worker for Cancer of Unknown Primary patients
To assess, plan and implement acute nursing care in accordance with local and National guidelines

4. Overview of the Acute Oncology Service
To liaise with chemotherapy triage nurse and other chemotherapy professionals
To analyse and react upon haematology and biochemistry results
To act as support and information source for patients and families
To act as a link between Oncologists, ED, Medical, Surgical clinicians, GP’s, patients and their families
Oncologists based at Castle Hill Hospital
Haematologists based at York Hospital

5. Cancer therapies Chemotherapy Immunotherapy Targeted therapies
Monoclonal antibodies
Radiotherapy
Supportive therapies

6. TARGETED THERAPIES (also known as biological therapies)
Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer.
Tend to be better tolerated
Often given in combination with chemotherapy
Important to remember that side effects and toxicities from targeted therapies can present up to 6 months from completion of treatment

7. Monoclonal antibodies
Rituximab..has been used for many years
Indications : NHL, CLL
Bevacizumab..Also known as Avastin
Indications : Colorectal, NSCLC, Ovarian
Trastuzumab.. Also known as Herceptin
Indications : Breast, Oesophogeal

8. Other Biological / Targeted Therapies
Erlotinib (tarceva) used for Non Small Cell Lung Cancer, a tyrokinase inhibitor
Sorafenib used to treat some kidney and liver malignancies
Dasatanib used for Chronic Myeloid Leukaemia
Bortezemib (Velcade) Used to treat Myeloma

9. EGFR (Epidermal Growth Factor Receptor)
Epidermal growth factor (EGF) is a growth factor that stimulates cell growth, proliferation, and differentiation by binding to its receptor EGFR. Targeted therapies harness the potential of the receptor within the epiderm, hence when a patient develops a rash with treatment it is often a sign that the treatment is being effective. Some MOABs and TKIs are targeted to the EGFR

10. Complications/Side effects of cancer treatment
Febrile Neutropenia/Neutropenic sepsis
Malignant Spinal Cord Compression (MSCC)
Superior Vena Cava Obstruction
Suspected PE/DVT
Nausea and vomiting
Diarrhoea
Constipation
Electrolyte imbalances
Hypo/Hypercalcaemia

11. Complications/Side effects of cancer treatment
Hypomagnesaemia
Bone marrow suppression causing pancytopenia
Mucositis
Palmar Plantar Erythema (PPE)
Rash
Pleural effusions
Ascites

12. Neutropenic Sepsis/Febrile Neutropenia
Neutrophils <1
Nadir usually between 7-14 days depending on treatment regimen
Fever, but often with no other symptoms, expect rapid deterioration. Do not wait for blood results – treat!
Blood cultures must be taken; 2 sets peripherally and 1 set from any lines
Broad spectrum antibiotics within the hour;
Tazocin plus Gentamicin if severe sepsis
For non-severe penicillin allergy:
Meropenum
For severe penicillin allergy
Vancomycin and Aztreonam

13. Neutropenic Sepsis/Febrile Neutropenia
Patients advised to monitor their temperature daily whilst having chemotherapy.
For daily FBC, once neutrophils equal to or above 1 and patient is well, for discharge from hospital.
May need dose reduction or Granulocyte-Colony Stimulating Factor (G-CSF) adding to next cycle.

14. MSCC 3-5% pts with cancer 10% patients with spinal mets
Compression site:
70%Thoracic
20% Lumbar/sacrum
10% Cervical
Common cancers associated with MSCC:
Breast
Prostate
Lung
Cancer of Unknown Primary
Lymphoma
Multiple myeloma

15. MSCC Suspect it…complete a neurological examination and consider:
Is the patient known to have skeletal mets?
Worsening or new onset of spinal pain?
Nocturnal spinal pain disturbing sleep?
Gait disturbance?
Spinal pain on lying flat or on straining e.g. coughing, sneezing?
Any limb weakness/numbness/tingling sensation?
Bowel and/or bowel problems

16. MSCC
If suspected give stat dose of 16mg dexamethasone with PPI cover
Refer to MSCC pathway:
Contact Acute Oncology CNS on /
Request urgent MRI and obtain verbal report
If confirmed MSCC:
Patient will be referred to the neurosurgeons at HRI via referapatient.org. If accepted patient will be transferred to Ward 4 when bed available.
If not for neuro intervention;
Transfer arranged to CHH, via bleep 500 and discussed with
Oncology SpR on call, patient will need urgent radiotherapy.

17. SVCO Most common in lung cancer patients Symptoms/signs:
Breathlessness is the most common symptom (>60%)
Swelling or discolouration of the face and neck
Feeling of fullness in the head
Bending forward or lying flat may aggravate signs and symptoms
Non-pulsatile raised jugular venous pulse [JVP]
Dilated anterior chest wall and neck veins

18. SVCO Investigations: Treatment: Chest x-ray / CT Thorax
Dexamethasone 16mg with PPI cover
Vascular stent (not available at SGH)
Chemotherapy for small cell lung cancer and lymphoma
Radiotherapy for non-small cell lung cancer

19. MUO/CUP referrals Refer patient via 2WW
Contact Acute Oncology/CUP CNS’ to make them aware of the referral and for any advice regarding further investigations
Request urgent CT chest, abdomen and pelvis

20. AO Contact details Julie Skelton – Lead Acute Oncology CNS
Tel 6236 /
Kristen Gibson – Acute Oncology CNS
Tel 6236 /
Working hours Monday – Friday 8am – 6pm

21. Any questions?
Thank you